5 research outputs found
Predictors of Hepatitis Knowledge Improvement Among Methadone Maintained Clients Enrolled in a Hepatitis Intervention Program
This randomized, controlled study (n = 256) was conducted to compare three interventions designed to promote hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination completion, among clients undergoing methadone maintenance treatment (MMT) in Los Angeles and Santa Monica. The participants were randomized into three groups: Motivational Interviewing-Single Session (MI-Single), Motivational Interviewing-Group (MI-Group), or Nurse-Led Hepatitis Health Promotion (HHP). All three treatment groups received the 3-series HAV/HBV vaccine. The MI sessions were provided by trained therapists, the Nurse-Led HHP sessions were delivered by a research nurse. The main outcome variable of interest was improvement in HBV and HCV knowledge, measured by a 6-item HBV and a 7-item HCV knowledge and attitude tool that was administered at baseline and at 6-month follow-up. The study results showed that there was a significant increase in HBV- and HCV-related knowledge across all three groups (p < 0.0001). There were no significant differences found with respect to knowledge acquisition among the groups. Irrespective of treatment group, gender (P = 0.008), study site (P < 0.0001) and whether a participant was abused as a child (P = 0.017) were all found to be predictors of HCV knowledge improvement; only recruitment site (P < 0.0001) was found to be a predictor of HBV knowledge. The authors concluded that, although MI-Single, MI-Group and Nurse-Led HHP are all effective in promoting HBV and HCV knowledge acquisition among MMT clients, Nurse-Led HHP may be the method of choice for this population as it may be easier to integrate and with additional investigation may prove to be more cost efficient
Medication errors in the Middle East countries: a systematic review of the literature
Background: Medication errors are a significant global concern and can cause serious medical consequences for
patients. Little is known about medication errors in Middle
Eastern countries. The objectives of this systematic review
were to review studies of the incidence and types of medication errors in Middle Eastern countries and to identify the main contributory factors involved.
Methods: A systematic review of the literature related to medication errors in Middle Eastern countries was conducted in October 2011 using the following databases: Embase, Medline, Pubmed, the British Nursing Index and the Cumulative Index to Nursing & Allied Health Literature. The search strategy included all ages and languages. Inclusion criteria were that the studies assessed or discussed the incidence of medication errors and contributory factors to medication errors during the medication treatment process in adults or in children.
Results: Forty-five studies from 10 of the 15 Middle Eastern
countries met the inclusion criteria. Nine (20%) studies focused on medication errors in paediatric patients. Twenty-one focused on prescribing errors, 11 measured administration errors, 12 were interventional studies and one assessed transcribing errors. Dispensing and documentation errors were inadequately evaluated. Error rates varied from 7.1% to 90.5% for prescribing and from 9.4% to 80% for administration.
The most common types of prescribing errors reported
were incorrect dose (with an incidence rate from 0.15% to
34.8% of prescriptions), wrong frequency and wrong
strength. Computerised physician rder entry and clinical pharmacist input were the main interventions evaluated. Poor
knowledge of medicines was identified as a contributory
factor for errors by both doctors (prescribers) and nurses
(when administering drugs). Most studies did not assess the
clinical severity of the medication errors.
Conclusion: Studies related to medication errors in the Middle Eastern countries were relatively few in number and of poor quality. Educational programmes on drug therapy for doctors and nurses are urgently needed
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Prevention of a First Stroke: A Review of Guidelines and a Multidisciplinary Consensus Statement From the National Stroke Association
OBJECTIVE To establish, in a single resource, up-to-date
recommendations for primary care physicians regarding prevention
strategies for a first stroke. PARTICIPANTS Members of the National Stroke Association's
(NSA's) Stroke Prevention Advisory Board and Cedars-Sinai Health
System Department of Health Services Research convened on April 9,
1998, in an open meeting. The conference attendees, selected to
participate by the NSA, were recognized experts in neurology (9),
cardiology (2), family practice (1), nursing (1), physician assistant
practices (1), and health services research (2). EVIDENCE A literature review was carried out by the Department of
Health Services Research, Cedars-Sinai Health System, Los Angeles,
Calif, using the MEDLINE database search for 1990 through April 1998
and updated in November 1998. English-language guidelines, statements,
meta-analyses, and overviews on prevention of a first stroke were
reviewed. CONSENSUS PROCESS At the meeting, members of the advisory board
identified 6 important stroke risk factors (hypertension, myocardial
infarction [MI], atrial fibrillation, diabetes mellitus, blood
lipids, asymptomatic carotid artery stenosis), and 4 lifestyle factors
(cigarette smoking, alcohol use, physical activity, diet). CONCLUSIONS Several interventions that modify well-documented and
treatable cardiovascular and cerebrovascular risk factors can reduce
the risk of a first stroke. Good evidence for direct stroke reduction
exists for hypertension treatment; using warfarin for patients after MI
who have atrial fibrillation, decreased left ventricular ejection
fraction, or left ventricular thrombus; using 3-hydroxy-3
methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors for patients
after MI; using warfarin for patients with atrial fibrillation and
specific risk factors; and performing carotid endarterectomy for
patients with stenosis of at least 60%. Observational studies support
the role of modifying lifestyle-related risk factors (eg, smoking,
alcohol use, physical activity, diet) in stroke prevention. Measures to
help patients improve adherence are an important component of a stroke
prevention plan
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Factors Associated With Large Improvements in Health-Related Quality of Life in Patients With Atrial Fibrillation
BackgroundAtrial fibrillation (AF) adversely impacts health-related quality of life (hrQoL). While some patients demonstrate improvements in hrQoL, the factors associated with large improvements in hrQoL are not well described.MethodsWe assessed factors associated with a 1-year increase in the Atrial Fibrillation Effect on Quality-of-Life score of 1 SD (â„18 points; 3Ă clinically important difference), among outpatients in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation I registry.ResultsOverall, 28% (181/636) of patients had such a hrQoL improvement. Compared with patients not showing large hrQoL improvement, they were of similar age (median 73 versus 74, P=0.3), equally likely to be female (44% versus 48%, P=0.3), but more likely to have newly diagnosed AF at baseline (18% versus 8%; P=0.0004), prior antiarrhythmic drug use (52% versus 40%, P=0.005), baseline antiarrhythmic drug use (34.8% versus 26.8%, P=0.045), and more likely to undergo AF-related procedures during follow-up (AF ablation: 6.6% versus 2.0%, P=0.003; cardioversion: 12.2% versus 5.9%, P=0.008). In multivariable analysis, a history of alcohol abuse (adjusted OR, 2.41; P=0.01) and increased baseline diastolic blood pressure (adjusted OR, 1.23 per 10-point increase and >65 mmâHg; P=0.04) were associated with large improvements in hrQoL at 1 year, whereas patients with prior stroke/transient ischemic attack, chronic obstructive pulmonary disease, and peripheral arterial disease were less likely to improve (P<0.05 for each).ConclusionsIn this national registry of patients with AF, potentially treatable AF risk factors are associated with large hrQoL improvement, whereas less reversible conditions appeared negatively associated with hrQoL improvement. Understanding which patients are most likely to have large hrQoL improvement may facilitate targeting interventions for high-value care that optimizes patient-reported outcomes in AF. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710